Figure 1 - uploaded by Helen A. Merritt
Content may be subject to copyright.
Histologic findings in juvenile ossifying fibroma. a Cellular tumor with multiple psammomatous calcifications. HE. ×100. b High-power magnification revealing bland, short spindle cells and calcifications. HE. ×400.
Source publication
Benign mesenchymal tumors of the craniofacial complex present unique challenges for orbital surgeons because of their potential for orbital compartment syndrome, ocular morbidity, and facial disfigurement and because definitive surgical management may be associated with significant morbidity. While the precise classification of such lesions depends...
Context in source publication
Context 1
... August 2006, after the patient had complained of swelling of the left jaw for 2 weeks, he was found to have an osteolytic lesion involving the left mandible. A biopsy confirmed the diagnosis of juvenile active ossifying fibroma ( fig. 1 ), and the patient was treated with complete surgical resection in January 2007. He was also found to have a left parathyroid adenoma with associated hyperparathyroidism in March 2010 and was treated with surgical ...
Similar publications
Background:
Reactive localized hyperplastic lesions of the oral cavity (RHLs) are relatively common peripheral lesions which present as a range of clinically similar lesions at dental centers. Diagnosis can be challenging if dentists are unfamiliar with their clinicopathological across various populations.
Objective:
This study reviews the patte...
Citations
... Medical treatment with bisphosphonates, however, has demonstrated varying results, with some papers reporting utility and others conferring treatment failure [12,13]. Lastly, denosumab is a monoclonal antibody targeting the RANK ligand that has shown to be promising for slowing tumor progression and pain [14] Further studies are required to determine utility in cases of optic nerve compression [15]. ...
... There are traditional two modalities of treatment: for tumour localized close to the optic nerve, total or subtotal surgical resection is done immediately; for asymptomatic cases, especially in elderly patients, the initial treatment consists of observation and follow up with periodic imaging controls considering the slow growth pattern of the osteoma. External surgical approaches include coronal, transcaruncular, tranconjunctival, and transblepharoplasty incisions [12,13]. The most appropriate method is selected according to location, tumour volume, anatomical situation, and sinus extension [14]. ...
Osteoma is a benign bone tumour, with an incidence of 2% of all orbital tumours. Osteomas located in orbit remain asymptomatic until they reach a size that originates mass effect signs such as exophthalmos, diplopia, and unilateral blindness. Materials and methods. In this case, a male patient presented to the emergency room with progressive proptosis, worsening headaches, and swelling of the left anterior periorbital and frontal sinus region one year after the beginning of the symptoms. Results. Imaging studies revealed a hyperdense mass in the left orbital floor displacing the left globe superiorly and anteriorly with the optic nerve’s compression. Conclusion. Osteoma may represent an emergency in the long term when left untreated; it may destruct the eye due to direct pressure on the optic nerve and disturbance of the ocular blood supply.
... Non-ossifying fibroma (fibroxanthoma) is a common non-neoplastic bone lesion, which occurs in the metaphysis of the paediatric patients and histologically characterised by the presence of proliferating spindleshaped, bland fibroblasts that arranged in short fascicles and storiform pattern, fibrotic stroma and minor component of scattered osteoclast-type multinucleated giant cells [22]. Another important histological differential diagnosis is primary aneurysmal bone cyst, which is a benign, oseolytic and expansile bone lesion, typically involves the long bones but may rarely arise in the orbit, most commonly in the orbital roof [23,24]. It is characterised by forming variably-sized, blood-filled spaces that are separated by variable amount of fibrotic stroma. ...
Giant cell tumour (GCT) of the bone is generally a benign but locally aggressive tumour that is primarily composed of multinucleated osteoclast-like giant cells with a background of neoplastic mononuclear stromal cells. It predominantly occurs in the epiphysis and metaphysis of the long bones but it can occur in an unusual locations. Giant cell tumour of the skull is rare and GCT of the orbital bones account for less than 1% of all GCTs. Accurate histopathological diagnosis of GCT and differentiating GCT from other pathological mimickers are important as the GCT has a tendency for local recurrence in incompletely resected cases and in the view of the recently emerging targeted therapy for GCT. Herein we present a case of orbital GCT, which occurred in the left orbital roof in a 6-year-old girl. The tumour was surgically resected and the patient remained with no evidence of residual or recurrent disease after 42 months postoperative follow-up
period. In addition, we review the histopathological mimickers of GCT with an emphasis on the pathological diagnostic pitfalls.
... A randomized double-blind controlled study by de Lange et al. (2006) included 14 patients with central giant cell granuloma of the jaw found no significant reduction in the size of the lesions between patients treated with calcitonin therapy and the placebo group. Merritt et al. (2015) reported a case of juvenile ossifying fibroma of the mandible which was managed with calcitonin therapy however the lesion continued to progress and spread into both orbits despite this intervention. The authors concluded that calcitonin therapy was not effective in the management of such lesions. ...
Ossifying fibroma (OF) is the most frequent of the three fibro-osseous lesions of the jaws. It occurs mostly in patients between the age of 20 and 40 years. Females are more commonly affected than males. Clinically, OF usually presents as a painless expansive intra-bony mass. Swelling and pain may be present in some cases while some lesions are discovered incidentally. Radiographically, OF is usually well-defined and unilocular or multilocular. Early lesions present as well-defined radiolucency that are small in size. Over time, the lesions tend to enlarge in size and become mixed radiolucent-radiopaque and finally become completely radiopaque. The aim of this study was to determine the clinical and radiological features of ossifying fibroma presenting at the Departments of Maxillo-Facial and Oral Surgery and Diagnostics and Radiology, University of the Western Cape Oral Health Centre as well as to assess its management and recurrence patterns. A retrospective case series analysis was performed of all histopathologically diagnosed ossifying fibroma cases available at the Departments of Maxillo-Facial and Oral Surgery and Diagnostics and Radiology at the Faculty of Dentistry, University of the Western Cape from 1976-2014. Patient's age, gender and ethnicity were recorded. The clinical presentation of the lesion as well as the history was analyzed. Radiographic features including density, size, shape, location, locularity and its effect on adjacent structures was noted. Management of each case and follow-up was also documented. A total 61 cases were included in the study. The majority of patients were females (63.9%) and below 40 years of age (73.9%). Few cases were symptomatic (29.5%) with an average period 22 months from first symptoms to presentation. The mandibular posterior region was most affected (55.5%) while larger lesions occurred more frequently in younger patients. Majority of lesions were radiopaque (49.2%) and had well-defined margins (93.6%). Most cases were managed by surgical curettage (68.2%). Following an average follow-up period of 20 months only one case recurred (recurrence rate =6.7%). In conclusion, the majority of the clinical and radiographic findings of ossifying fibroma were similar in South African patients as those of other populations. Differences include that the lesions in this population were more radio-opaque and larger in size than in the reported literature. Surgical curettage is an acceptable management protocol with low rate of recurrence.
The term fibro-osseous lesion applies to a broad range of pathologic conditions in which bone is replaced with a connective tissue matrix. The majority of these conditions are benign, but osteosarcoma, a malignant lesion, can also be categorized as a fibro-osseous lesion. The orbit and optic canal are rarely affected by such lesions in isolation, but rather are involved by the close proximity of the orbital complex with the paranasal sinuses and skull base. The most common fibro-osseous lesions observed in the craniofacial region, which are generally amenable to endoscopic or combined endoscopic and open surgical procedures, are reviewed in this chapter, including osteoma, osteoblastoma, osteoclastoma, ossifying fibroma, fibrous dysplasia, and osteosarcoma. Clinical and radiographic presentation of each condition along with treatment approaches and recommendations are discussed.
Introduction
Cemento-ossifying fibromas are rare, benign lesions of the head and neck regions. The origin of these lesions can be traced to the periodontal ligament, because its cells are able to form cement, lamellar bone, or fibrous tissue.
Case presentation
A rare case report of a young Caucasian female with a COF is described including follow-ups. She remained untreated for several years despite early radiographic findings of the lesion without a definitive diagnosis. The patient ultimately underwent radical surgery and the whole lesion was removed. The subsequent histological examination confirmed the clinical diagnosis of a COF. Since then, the patient has been under regular clinical and radiological follow-ups.
Discussion
This rare case report of a COF, documented over 18 years, shows the importance of consecutive therapy after radiologic and clinical findings, as such lesions continue growing and may subsequently lead to severe medical conditions. Therefore, complete surgical resection of COFs is advised to achieve good results in terms of health and recurrence.
Conclusion
Long-term follow-up of patients is required as recurrences can occur for up to 10 years following treatment. Well-planned radical and wide surgical resection of these lesions has proven not only to be effective in eliminating the aetiological factors, but can also achieve decent bone regeneration and aesthetic results with almost no deformation in the surgical site.
A case is presented of a 5 year-old patient with bilateral hereditary retinoblastoma treated with radiotherapy in the right eye and enucleation of the left eye. After three years without evidence of progression, the patient presented with a right orbital mass that compromised the frontal bone. After surgical excision, the histology analysis was consistent with a diagnosis of giant cell tumour.
Primary orbital bone neoplasms, such as giant cell tumours, are extremely rare. Both radiological and histopathology studies are essential to establish the differential diagnosis of orbital mass lesions.
Resumen
Paciente de 5 años de edad con diagnóstico de retinoblastoma hereditario bilateral tratada con radioterapia en el ojo izquierdo (OS) y enucleación del ojo derecho (OD). Después de 3 años sin evidencia de progresión presenta una nueva masa tumoral en la órbita derecha, con compromiso del techo, cuyo diagnóstico anatomopatológico tras su exéresis mediante abordaje neuroquirúrgico resultó ser de tumor óseo de células gigantes.
Los tumores óseos primarios de la órbita como el tumor de células gigantes son una entidad poco frecuente. Los estudios radiológicos y anatomopatológicos resultan esenciales para establecer el diagnóstico diferencial de las lesiones que asientan en la órbita.
